Wednesday, July 21, 2010

ADCOM Q&A (working under pressure)

Being a doctor is, quite often, about working well under pressure. If someone stops breathing, for example, you better figure out how to get them breathing again, and quick! There is no time for consulting the Internet, a textbook, or (very often) other doctors. You must act. Now. Or someone might die.

That's why ADCOMS often ask pre-medical students a variation on this question (which I found on the Internet on a list of practice questions): How do you work under pressure? Give an example. What, in hindsight, were you most dissatisfied with about your performance? What did you learn from your experience?

"I'm no stranger to working under pressure," I thought when I read that question. And that is the truth. For the year and a half that I worked at the Forest Park Review, a local weekly newspaper in the Chicago suburbs, "pressure" was my constant companion. (And this was my first job out of college, so I learned it early.)

It was especially intense, though, on Tuesday mornings. That was deadline day, when the paper was sent to the printer. I would wake up at 2 or 3 a.m. in order to write a half-dozen or so stories and an editorial by 7 or 7:30 a.m. And then I would go to the office. What for? For another three hours of deadline drama: writing headlines, creating captions, approving page layouts, and so on. It was grueling.

But through it all, I had to be at peak performance. Exhaustion was no excuse. I had to get the facts right, get the dates right, and get people's names right. And do it all in captivating prose. Oh, right -- make that captivating prose in less than 700 words per story.

But I didn't need any excuses. In fact, I kicked things up a notch on deadline day. I was intense, driven, focused. When I have a goal, and time constraints for completing that goal, I find myself subdividing time into estimated allotments for each portion of the task I have to complete. This helps me stay on track so that I don't spend too much time doing any one thing. On deadline day, that might mean 30 minutes for one story, and one hour for another. (I prioritized as well as subdivided.)

The process was intense, and I was intense during the process. It was hard to turn that intensity off right away. So when I'd leave the newsroom at around 11:30 a.m. or noon, snippets of stories would float through my mind. And I would question myself: Did I do X right? Did I change Y like I told myself I needed to? Maybe I should have opened that one story with another lede ...

Then when I saw the newspaper the next day, I saw the in most cases, yes, I did do X right, I did change Y, and in actuality the lede I opened on that one story with was fantastic.

I gradually learned to trust myself, not to second-guess myself in those high-pressure situations. Because I knew what I was doing, I really did, I just needed to BELIEVE that I knew what I was doing, and go with that. Because it was often the second-guessing that led to the mistakes.

This is an essential skill for a physician to have. There is often no time for second-guessing. Making a second guess might mean your first act is one moment too late. So trusting yourself, your skills, and also your intuition, is something that a physician must do ... is something that hopefully I will one day do.